Optimizing Engagement in Services for First-Episode Psychosis (FEP) in the Community Mental Health Setting

摘要 对于首次精神病发作的个人来说，脱离服务是一个主要的公共卫生问题 (FEP)高达40%的人过早终止早期护理。因此，患有FEP的个人在 持续性症状和功能障碍的风险增加，长期结局不良。接合 可以通过以下方式得到改善：（1）确定务实有效的循证干预措施，（2）查明 实现参与变化的机制，以及（3）加强关于 参与，例如通过制定一个细致入微的和动态的参与概念，以指导未来 research.在美国，社区心理健康尤其需要有效的干预措施， 卫生服务，提供大多数精神卫生保健，并遇到重大的参与问题，并为困难- 以达到社区，如那些由拉丁美洲人组成的。对患有以下疾病的个人进行的研究 精神病已经表明，行为激活（BA）可以有效地靶向参与， 功能性成果。本研究将为FEP开发12次BA，并将其与常规治疗进行比较 超过六个月的样本58（每种条件29）拉丁美洲人和他们的家庭照顾者在纵向 随机对照试验。Dyads还将参加类似的家庭支持小组， 按条件分开。研究变化的机制，干预介质之间的关联 和参与将被检查，以确定是否在调解人的变化之前， 随着时间的推移。使用混合方法，地方/文化因素与参与之间的关系 将被探索。定性方法将用于探讨当地/文化因素如何影响参与， 未来的定量分析，稳健预测器的具体特征（例如，家庭支持）影响 参与，发现其他关键影响，考虑BA的具体因素，并生成一个模型， 参与FEP护理，关注发展阶段，疾病和治疗。该项目提供 培训家庭暴力方案的服务参与和干预，制定和应用家庭暴力方案的学士学位，解决 在FEP期间，以文化响应和相关研究的方式参与难以到达的社区 方法与主要导师，亚历克斯Kopelowicz，医学博士，共同导师史蒂芬R。洛佩斯博士，丽莎B。医学博士狄克逊， M.P.H.和索纳·迪米吉安博士和顾问希拉里·梅尔斯博士，Anahi Collado博士，Mark Lai博士， 朱迪·厄尔曼博士，Lawrence Palinkas博士，Ethel Nicdao博士活动将通过以下方式持续进行： 与加州州立大学圣贝纳迪诺的培训师和资源定期沟通， 南加州大学及相关机构/地点。培训支持桑托斯博士的长期目标 为来自偏远社区的FEP患者提供服务。的 该项目将加强FEP的参与和干预领域，并支持NIMH的目标， 参与和最大限度地恢复早期精神病患者。

Abstract Disengagement from services is a major public health problem for individuals with first-episode psychosis (FEP) as up to 40% of individuals prematurely terminate early care. Individuals with FEP are consequently at increased risk of persistent symptomatic and functional impairment and poor long-term outcomes. Engagement can be improved by (1) identifying pragmatic and effective evidence-based interventions, (2) pinpointing the mechanisms through which change in engagement is achieved, and (3) enhancing the literature on engagement, such as by developing a nuanced and dynamic conceptualization of engagement to guide future research. In the U.S., effective interventions for engagement are particularly needed for community mental health services, which deliver most mental health care and encounter major engagement issues, and for hard- to-reach communities, such as those comprised by Latinos. Research conducted with individuals with psychosis has shown that Behavioral Activation (BA) may effectively target engagement and also symptomatic and functional outcomes. This study will develop 12-session BA for FEP and compare it to treatment-as-usual over six months with a sample of 58 (29 per condition) Latinos and their family caregivers in a longitudinal randomized controlled trial. Dyads will also participate in comparable family support groups delivered separately by condition. To examine mechanisms of change, the association between intervention mediators and engagement will be examined to determine whether changes in mediators precede changes in engagement over time. Using mixed-methods, the relationship between local/cultural factors and engagement will be explored. Qualitative methods will be used to explore how local/cultural factors impact engagement for future quantitative analysis, how specific characteristics of robust predictors (e.g., family support) influence engagement, discover other critical influences, consider BA specific factors, and generate a model of engagement in FEP care with attention to stages of development, illness, and treatment. The project provides training in service engagement and intervention for FEP, developing and applying BA for FEP, addressing engagement during FEP in hard-to-reach communities with cultural responsivity, and relevant research methods with primary mentor, Alex Kopelowicz, M.D, co-mentors Steven R. Lopez, Ph.D., Lisa B. Dixon, M.D., M.P.H., and Sona Dimidjian, Ph.D., and consultants Hilary Mairs, Ph.D., Anahi Collado, Ph.D., Mark Lai, Ph.D., Jodie Ullman, Ph.D., Lawrence Palinkas, Ph.D., and Ethel Nicdao, Ph.D. Activities will be sustained through regular communication with and between trainers and resources at California State University San Bernardino, University of Southern California, and relevant institutions/sites. Training supports Dr. Santos’s long-term goal of advancing the field of service engagement for persons with FEP from hard-to-reach communities. The project will enhance the FEP engagement and intervention field and supports the NIMH’s goals of improving engagement and maximizing recovery for persons with early psychotic illness.